63 - Manubriosternal Syndrome

Abstract

Pain originating from the manubriosternal joint can mimic pain of cardiac origin. The manubriosternal joint is susceptible to the development of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome, and psoriatic arthritis. The joint can also be traumatized during acceleration–deceleration injuries and blunt trauma to the chest. With severe trauma, the joint may subluxate or dislocate. Overuse or misuse can result in acute inflammation of the manubriosternal joint, which can be quite debilitating. The joint is also subject to invasion by tumor from primary malignant tumors, including thymoma, or from metastatic disease. Rarely, septic arthritis of the manubriosternal joint can occur. Physical examination of patients suffering from manubriosternal syndrome reveals that the patient vigorously attempts to splint the joint by keeping the shoulders stiffly in a neutral position. Pain is reproduced with active protraction or retraction of the shoulder, deep inspiration, and full elevation of the arm. Shrugging off the shoulder may also reproduce the pain. Coughing may be difficult, leading to inadequate pulmonary toilet in patients who have sustained trauma to the anterior chest wall. The manubriosternal joint may be tender to palpation. The patient may also complain of a clicking sensation with movement of the joint.